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How Not To Do Bioethical Reasoning

The March 2018 edition of the prestigious AMA Journal of Ethics  has published an article entitled: Why Crisis Pregnancy Centers [CPCs] Are Legal but Unethical [1].  The authors, both of whom identify their chief research interest as “abortion” (1 [2] & 2 [3] ), argue that religiously-driven ideology motivates CPCs to engage in a campaign of deception against vulnerable women in order to undermine the noble aims of the nation’s network of abortion clinics.

The AMA essay is an example of contemporary bioethical reasoning inasmuch as the premises it draws upon are the four commonly accepted secular “principles of medical ethics:” (i) beneficence, (ii) nonmaleficence, (iii) autonomy and (iv) justice.  It is also particularly noteworthy for being a good example of bad ethical reasoning.  Hence, it may be instructive to review its arguments in order to see where its weaknesses lie.

The Four Principles of Medical Ethics

The four principles prescribe the following:

  1. Beneficence  prescribes that clinicians should always aim to do good to their patients;
  2. Nonmaleficence  prescribes they should never do evil;
  3. Autonomy  requires that free and informed consent should be facilitated in every reasonable way, especially by the provision of all facts relevant to making a good decision about medical care; and
  4. Justice  requires that all patients should be treated fairly.

These principles can be summarized in the following single comprehensive moral norm:

All medical counsel and every medical alternative proposed to or carried out on patients by clinicians, including by clinic workers, should be consistent with the patients’ integral wellbeing (physical, mental, relational and spiritual), and, at very least, should never intentionally attack or destroy any human good, nor subject anyone unfairly to any type of harm.

The Claim: CPCs Violate All Four Principles

The essay argues that CPCs violate beneficence and nonmaleficence because they engage in “deceptive practices” giving the false “impression of being medical clinics;” they “not only discourage abortion but also refuse to provide referrals to abortion clinics;” they counsel on “dangers associated with premarital sexual activity,” but their abortion counseling “falls outside accepted medical standards;” and they set up near abortion clinics so women “mistakenly seek [abortion] care there rather than at the intended clinic.”

They violate autonomy  because “by placing ideology over accurate and comprehensive counseling,” they deny a woman the information she needs “to make the decision that is best for her life and circumstances.”

And they violate justice by “target(ing) low-income women and women of color, adolescents, and women with less formal education,” thus “propagat(ing) racial, ethnic, and socioeconomic inequities,” and leaving these vulnerable women “exposed to the greater health risk of carrying a pregnancy to term.”

Therefore, CPCs should be legally required to provide “honest information” about pregnancy, abortion and abortion referrals; they should be prohibited from using “language to … dissuade [women] from having abortions.”  And until they “conform to ethical standards [similar to] licensed medical facilities … states should refrain from directly or indirectly funding these centers.”

Reply And Critique

Let us look at the essay’s flaws.  The first is that it uses morally-evaluative language (such as “ideology,” “deceptive,” “misleading,” “false information,” “target,” “propagate”) that presumes its own conclusion that CPCs are unethical.

If we reformulate the essay’s criticisms without using evaluative language we can assess more easily whether CPCs are doing anything unethical.  The essays criticisms can be summarized as follows: CPCs …

  1. Give the impression they provide full-service counseling for women with problem pregnancies;
  2. Refuse to refer for abortions or provide other information necessary to procuring abortions;
  3. Defend premarital chastity;
  4. Fail to conform to abortion-friendly standards of other parts of the healthcare community;
  5. Set up near abortion clinics; and
  6. Reach out to the poor and less educated women, to youth and to ethnic minorities.

Now let us assess these complaints in the light of our single comprehensive norm.  Recall the norm requires clinicians to exclude every alternative that destroys human good and violates the physical, mental, relational or spiritual flourishing of women who are struggling with problem pregnancies.  Doing this, we are required to exclude the performing or counseling in favor of abortion, since abortion destroys human life, shatters the mother-child relationship and often leads to pathological psychological distress.

Since, therefore, abortion is not a medical, therapeutic or morally-valid service to offer anyone, for any reason, failing to provide information about it, or to refer for it, or to conform to abortion-friendly standards; or trying to persuade women away from it in respectful ways; or setting up near abortion clinics to offer life-saving alternatives; or teaching lifestyle habits that help women not to find themselves carrying problem pregnancies, are not only not morally wrong, they are required  of any decent citizenry in a free society.  And doing them especially for women who are most vulnerable to the abortion culture (e.g., the poor, under-educated, youth, etc.) is a requisite of fairness.

The authors are frustrated because CPCs won’t accept abortion clinics as valid alternatives for dealing with problem pregnancies.  But CPCs came into existence on the premise that abortion clinics do horrible things and are devoid of moral legitimacy.  Given its tendentious nature, the essay is unlikely to persuade anyone not already convinced of its conclusion.  Thus, we are justified in concluding that its sole purpose is to persuade abortion-friendly judges to strike down laws empowering CPCs to do their good work.